Healthcare Provider Details

I. General information

NPI: 1598169682
Provider Name (Legal Business Name): GOOD LIFE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 LAKE DR SE SUITE 105
GRAND RAPIDS MI
49506-1674
US

IV. Provider business mailing address

1331 LAKE DR SE STE 105
GRAND RAPIDS MI
49506-1674
US

V. Phone/Fax

Practice location:
  • Phone: 616-248-9842
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RYAN S GARY
Title or Position: PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 616-248-9842